Letters

Bronchiolitis

EDITOR,--David Isaacs's editorial on bronchiolitis contains guidelines that should cause some concern.¹ Bronchiolitis does not always fit into the static categories of mild, moderate, or severe but can carry an infant through to an obtunded state relatively quickly. Thus the suggestion that babies with moderate disease with a respiratory rate of up to 70 can be observed at home is worrying. It is also of concern that pulse oximetry should be considered to be relevant outside hospital. If the problem is indeed in the airways and not an interstitial lung problem then oxygen saturation should remain normal until the point at which respiratory muscle fatigue occurs. Other clinical observations in association with an increasing tachypnoea, such as heart rate and level of responsiveness, should predict this event before decompensation occurs. At this point a child needs not only supplementary oxygen but ventilatory support, and the logistics . . . [Full text of this article]

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